"Sister" schools program tackles AIDS in Africa
"AIDS statistics are numbers with the tears washed off them. I think we're dealing with the tears," says one of the African health-care workers interviewed in a documentary about AIDS in Africa. In an effort to bridge the gap between the tears and the numbers, DMS infectious disease experts are teaming up with their counterparts in Tanzania.
One of the Tanzanian collaborators, Muhammad Bakari, M.D., says the first time he heard about HIV was as a fourth-year medical student in the 1980s. He thought it was a disease that occurred only in America. "I have witnessed the huge increase" in AIDS in Africa since then, he says. Sub-Saharan Africa is now the worst-affected region in the world, with the prevalence of HIV exceeding 30% of the population in some countries.
DMS's Ford von Reyn (top, in the dark suit) helped cut the ribbon to open a new cooperative clinic in Tanzania.
Bakari visited DMS for three weeks recently to learn about the clinical use of HIV antiviral medications in anticipation of their wider availability in Africa. "We don't have a lot of expertise," he says. Very few HIV-infected or AIDS patients in Tanzania are on them now.
Bakari is one of the principal investigators of what's called the DARDAR Health Study, a fiveyear trial, sponsored by the National Institutes of Health, of a vaccine aimed at preventing tuberculosis among people with HIV. The word "DARDAR" is a contraction of "Dartmouth-Dar es Salaam"; it also mimics the repeated syllables common in Kiswahili, one of the languages spoken in Tanzania, and is close to the word for "sister" (dada), thus representing the relationship between DMS and Tanzania's Muhimbili University College of Health and Sciences.
Infectious diseases: The DARDAR study has enrolled 600 patients so far and will ultimately include 2,300 people with HIV. Fordham von Reyn, M.D., chief of infectious diseases at Dartmouth, is a principal investigator, and Richard Waddell, Sc.D., director of HIV research studies, is a coinvestigator.
DARDAR is being conducted to determine why so many AIDS patients in Africa develop a severe form of tuberculosis (TB) that involves the spread of the organism through the bloodstream. They hope to prevent this complicationknown as disseminated TBwith a Mycobacterium vaccae vaccine. Disseminated TB occurs in 10% to 25% of those infected with HIV in Africa.
A new 10-room clinic building, funded by the DARDAR Study, opened in Dar es Salaam in June. The clinic includes a waiting room, exam rooms, and an x-ray facility, plus an office for DMS students who will help out there on electives.
"Approaches to care [in Tanzania] are more challenging because of the lack of availability of medications and antivirals," says Waddell. "The economic and cultural differences are dramatic. So it's critical for us to provide a venue for DMS students. They get experiences in infectious diseases first-hand that they [otherwise] only read about in textbooks."
Extreme poverty: TB flourishes where there's malnutrition and AIDS. Tanzania had a good TB control and prevention program until the mid 1980s, says Bakari. But extreme poverty, malnutrition, and overcrowding have been compounded by excessive debt and drug-patent issues that make medications unavailable to the poor.
It's surprising to Bakari that some people in the U.S. prefer not to take antiviral medications for HIV and AIDS because they don't like the side effects. "That would be unheard of" in my country, he says.
Laura Stephenson Carter
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